Dr. Kristin Guilliams: Hi, I'm Dr. Kristen Williams. I'm a pediatric neurologist and intensivist at St. Louis Children's Hospital, Washington University, and I'm so glad to be here today.

Melanie Cole: Welcome to Mom Docs, the podcast from St. Louis Children's Hospital. Today we're talking about pediatric strokes, what you really need to know. Dr. Williams, I'm so glad to have you join us today. I'd like you to start by telling the listeners, what is a stroke? actually happens in the brain when someone has a stroke?

Dr. Kristin Guilliams: so a stroke happens when there's a part of the brain that doesn't get enough blood. That can either be from a blood clot or blood blockage, and that's the medical term is ischemic stroke, or it can be because the blood burst out of the blood vessel before it can reach the tissue, and that's sometimes called a hemorrhagic stroke.

Melanie Cole: Are there risk factors for stroke in children? Because we hear about stroke. My dad had a stroke, but he was 95 years old. We hear about stroke in old people all the time, but we almost never hear about it in children. Are there certain conditions that would put a child at an increased risk for stroke?

Dr. Kristin Guilliams: That's a great question, especially because, thankfully, not as many children do have strokes compared to adults, but it is more common than many people realize. There are certain conditions that can increase the risk for stroke. Some of them might be things that a child is born with, such as congenital heart disease or sickle cell disease.

Melanie Cole: There's other times that there can be periods where things like trauma and injury to a head or neck vessel might increase the risk for stroke transiently. And then there's other times where we just didn't know that the child had a risk. for the stroke ahead of time, that we didn't know that their blood vessels in their brain were a little bit different than other kids.

Dr. Kristin Guilliams: And then there's sometimes we just don't know the exact cause for the stroke, but it's not from lack of looking or trying to figure it out.

Melanie Cole: Well, then, As parents are listening, you know, we're always watching our kids, Dr. Williams, for everything. We're looking at them, especially when they're little. Is everything okay? Is everything okay? And we've learned over the years about adults. We look for this be fast, right? Are there symptoms of stroke in children that we would notice?

Is it the same? Are these different from adult symptoms? Tell us a little bit about that.

Dr. Kristin Guilliams: Right, so for older children, meaning not babies, the symptoms actually are the same. And so if you see a child who suddenly can't move one side of their body or has difficulty speaking, that could be a stroke. Good news is, is in kids, it's not always a stroke. There are other things, it's like seizures or even complicated migraine headaches that can cause similar symptoms.

But it's the type of thing that we would want for people to come to the emergency room and let us be the ones to help figure that out. In

babies, it can look a little bit different, especially because sometimes babies can have strokes right around the period they're being born, that the period of time where the baby's getting ready to be born is one where the Coagulation and the blood clotting and bleeding system is a little complicated because it's trying to balance making sure that the blood flows easily to the baby through the umbilical cord, but also trying to prepare for birth and make sure that the mom doesn't hemorrhage out.

And so sometimes there can be small clots that travel from the and cause a stroke, and we don't always see those right away. One of the early signs can be if a baby has early hand preference. people really don't become truly left handed or right handed, usually until close to age three.

Sometimes, kids can be a little precocious and show it around age two but if there's a clear hand preference before a child's first birthday, that warrants a little bit further investigation as that can sometimes be a sign that the baby had had a stroke long ago.

Melanie Cole: Wow. So these are things that we might not actually notice at the time of the stroke, like with an older individual, but maybe something that previously happened. How do you then deter, if we notice that something's going on with one side of the body or any of those things that you just mentioned, and we take them in to our doctor or to urgent care or to the emergency room.

First of all, is time. As important as it is for an adult. Is there that same four hour window, which we're learning more and more about? Tell us a little bit about what's next.

Dr. Kristin Guilliams: Yes, time is still brain, particularly for the older children or if it's a sudden change that you notice to please seek. Emergency help right away, because if it is a stroke, then there sometimes can be therapies that we can give, just like in adults, like clot busting drugs or ways that for large clots, we can even remove the clot, but those are dependent on being time sensitive and have to happen within the first few hours of a clot being there. So, yes, come to the emergency room right away, places like here at St. Louis Children's Hospitals, we have a code stroke system where if any of our team members suspect that a child may be having a stroke, they can activate the team, who comes quickly to the bedside to evaluate and determine if we need imaging to help us determine and diagnose a stroke.

Melanie Cole: And then what happens? Because we also, we've heard TPA and, mechanical thrombectomy, all of these exciting advances in stroke medicine. But what tests? Would my child have? Tell us a little bit about what you do for a child that you've determined is actually in acute stroke or has had one previously.

Dr. Kristin Guilliams: We would get often a head CT and or often an MRI, and to take a look to see if there is a stroke or any bleeding. If it's within the time window and we suspect a possible stroke, particularly one from a blood clot then we can and have given clot busting drugs to children and or, taking them partnered with our partners at Barnes Hospital to help remove the clot and then bring them back to our pediatric ICU to recover from that.

Either way, when we do have an acute stroke, it is someone who is going to be admitted to one of our ICUs here at St. Louis Children's Hospital, where we'll have a team of not only critical care docs and nurses and therapists to help care for the child, but also neurologists who specialize in acute brain injury. And As we evaluate and follow along and make sure, see if we can figure out the reason for the stroke and to help the child recover any symptoms as soon as possible. What's really exciting here at St. Louis Children's Hospital is that we also have a fantastic neurorehabilitation team. and so sometimes after a child has had a stroke, particularly if they're still having problems with either moving or talking or thinking, that we can have them start their rehabilitation right here in St.

Louis Children's Hospital and spend a few weeks with intensive therapy to help them be their best selves as they continue to recover and transition back to home in their communities.

Melanie Cole: Dr. Williams says this is such a real exciting time in stroke medicine. There are so many advances happening so quickly, and we see in older people when we're using these treatments that we mentioned. Sometimes, they resume a near normal life. What do you see for children that have had a stroke, that have gotten into the program at St.

Louis Children's Hospital, done rehabilitation? What's life like then?

Dr. Kristin Guilliams: Yes, for many of our kids that they do much better, which is really exciting to see. I can think of several children who, you either, if they were able, one of whom who had a thrombectomy and he was doing so much better within a few days that he actually didn't have enough deficits to qualify for our rehabilitation team and did just outpatient therapy before he went back to school.

And then others I can think of who had start wIth the rehabilitation and they're now back in their communities and one of them is getting ready to go off to college, which is really exciting to see. And so we'll continue to partner and continue recovery. But we can't always get everyone back to their complete normal functioning.

Um, we will get them as high functioning and with maximal recovery as we can. And it's a. Partnered process, and the good news is recovery continues to happen even years after a stroke happens.

Melanie Cole: Well, thank you so much, Dr. Williams, for joining us and telling parents what we really need to know about pediatric stroke and the hope that's out there for a normal life. If after something like this could have happened. So thank you again for joining us. And for more advice and articles, please check out the Mom's Docs website at childrensmd.

org. That concludes another episode of Mom Docs with St. Louis Children's Hospital. I'm Melanie Cole. Thanks so much for joining us today.